Bidding farewell to the era of "incurable diseases", new therapies are giving children with leukemia new vitality

Pediatric acute lymphoblastic leukemia is the most common malignant tumor in children in China. Is leukemia an incurable disease? What kind of treatment can be chosen for children with the disease at home, and what matters need to be paid attention to in daily life? In this issue of the big coffee health class, Fang Yongjun, director of the Department of Hematology and Oncology of Nanjing Children's Hospital, came to take everyone to know this commonly known as "blood cancer" children's leukemia.

Correspondent Wu Yeqing

Yangzi Evening News/Purple Cow News trainee reporter Lu Yanlin

Filmed by Fang Hao

【Big Coffee Biography】

Fang Yongjun is the chief physician, professor and doctoral supervisor of the Department of Hematology and Oncology of the Children's Hospital Affiliated to Nanjing Medical University. He has been engaged in basic research and clinical work of childhood leukemia for 30 years. Key Talents of Women and Children of Jiangsu Province, Member of the Expert Committee of Pediatric Solid Tumors of the National Health Commission, National Member of the Hematology Group of the Pediatric Branch of the Chinese Medical Association, Deputy Leader of the Sub-specialty Group of Palliative Therapy, Leader of the Pediatric Hematology Group of the Pediatric Branch of the Jiangsu Medical Association, National Member of the Pediatric Oncology Professional Committee of the Chinese Anti-Cancer Association, Editorial Board Member of the Chinese Journal of Pediatric Blood and Oncology, Editorial Board Member of the Chinese Journal of Cancer Metastasis, Lymphoma Professional Committee of the Jiangsu Research Hospital Association, Vice Chairman of the Coagulation Committee, He is a member of the Hematology Branch of Nanjing Medical Association and a member of the Standing Committee of the Hemophilia Committee of the China Rare Disease Alliance. The first author and corresponding author published 40 SCI papers.

The cause of the disease is not clear, chemical pollution or "accomplice"

"Acute leukemia is the most common malignancy in childhood." Fang Yongjun told reporters that with the development of social economy and the effective control of infectious diseases, the incidence of malignant tumors, including leukemia, has shown a moderate upward trend, the state and society are highly concerned about the disease, and the understanding and judgment of the early symptoms of acute leukemia have also been significantly improved, and the medical treatment rate and cure rate have been significantly improved in recent years.

Image source: Visual China

Why do children get leukemia? Why does leukemia "do" my children?? Is leukemia possible to prevent? "In fact, the real cause of the disease is not clear." Fang Yongjun explained that for children, genetic factors do play a certain role in the pathogenesis of leukemia. "This genetic factor is not simply a genetic disease, but a disease that interacts with the environment. In the genetic process, certain genetic mutations can lead to susceptibility to tumors, such as Bloom syndrome, Down syndrome, neurofibromatosis, etc., which are high-risk factors. ”

Fang Yongjun told reporters that as all sectors of society have paid attention to, environmental factors have also played a great role in the process of causing diseases. "At present, the environmental disadvantages we know are mainly environmental pollution, that is, chemical pollution. This includes exposures such as decoration, inhalable organic compounds, X-ray exposures and much more. At the same time, the parents' drinking and smoking have become one of the "potential murderers". "In addition, improper diet is also leading to a high incidence of leukemia in some children. Previously, our research also found that some parents work outside the home, and children brought by grandparents may have an increased risk of disease due to poor dietary habits. ”

The long-term survival rate after treatment of acute lymphoblastic leukemia is as high as more than 90%.

Fang Yongjun introduced that the peak incidence of acute leukemia in children is usually between the ages of 2 and 6, and the disease is also the most effective malignant tumor in children. "In China, the long-term survival rate after treatment for acute lymphoblastic leukemia can reach more than 90%. The level of treatment for myeloid leukemia can also reach the level of long-term survival rate of 60%-70%. ”

The reporter learned that the current treatment method of leukemia is basically based on chemotherapy. "But chemotherapy for myeloid leukemia is not the same as for acute lymphoblastic leukemia." Fang Yongjun said that acute lymphoblastic leukemia pays attention to the induction, strengthening, consolidation and maintenance treatment for more than two years, and the overall disease-free survival rate can be more than 85%. On the other hand, the treatment of low-risk myeloid leukemia is still based on chemotherapy, but for medium- and high-risk myeloid leukemia, allogeneic hematopoietic stem cell transplantation has become a more suitable choice. "With the continuous improvement of hematopoietic stem cell transplantation technology in recent years, the application of anti-rejection, nutritional support and targeted therapy drugs, the level of allogeneic hematopoietic stem cell transplantation has also increased significantly, and the transplant-related mortality rate has been less than 10%. Although the overall therapeutic effect of acute myeloid leukemia is lower than that of acute lymphoblastic leukemia, chemotherapy plus hematopoietic stem cell transplantation can also achieve long-term disease-free survival of 60% to 70%. ”

New therapies such as small molecule targeting give new life to children

In Fang Yongjun's team, about 150 to 200 cases of acute lymphoblastic leukemia patients are admitted each year, and the newly diagnosed myeloid leukemia patients are about 30 to 40 cases, although the current treatment methods taken by patients close to 200 cases are still based on chemotherapy, but Fang Yongjun and his team have always actively explored.

"Our team is characterized by cord blood-based transplantation for high-risk lymphocytic leukemia." Fang Yongjun introduced that this is because the children are usually younger, and the long-term treatment effect of umbilical cord blood is good, and the recurrence rate is relatively low. "In addition, we have carried out bone marrow transplantation through the donation of some volunteers from the Chinese Bone Marrow Bank. Even when the epidemic situation in Nanjing was tense last year, the stem cell specimens could not be sent to Nanjing, and we also transported the specimens to Hefei and then retrieved them from the airport under the condition of strict compliance with the epidemic prevention requirements. It is understood that at the same time, for high-risk lymphocytes, in addition to the Chinese bone marrow bank and the cord blood bank, family members, that is, compatriots, can also be transplanted.

For myeloid leukemia with a relatively high degree of malignancy and a high recurrence rate, Fang Yongjun introduced that the typing method based on MICM (morphology, immunology and molecular genetics) is generally adopted. "Our team has a dedicated MICM laboratory platform, and for medium- and high-risk patients, there are often stronger induction treatments." At the same time, Fang Yongjun said that with the progress of molecular biotechnology, some small molecule targeted therapy, Car-T (cellular immunity), and monoclonal antibodies have been maturely applied. Fang Yongjun bluntly said that these new therapies have given new life to patients, especially high-risk patients with recurrence, and the era when the vast majority of leukemias were recognized as "incurable diseases" has passed.

If you have a small child at home, remember that a clean diet is the most important

With leukemia, can I still eat a normal diet? Is it no longer possible to eat "hair objects"? These problems often become the most common doubts of parents of sick children. Fang Yongjun stressed that children with leukemia can eat normally, but they must be clean and stay away from junk food. Especially for chemotherapy, when the white blood cells are very low, what you eat must be boiled, cooked, and cooked thoroughly. "If you eat fruit, you should eat peeled fruit, and you can't eat blueberries and strawberries that are easily contaminated to prevent the bacterial content from being too high and causing the infection to worsen."

For the anecdotal saying that such as the small rooster belongs to the "hair" can not eat, Fang Yongjun also explained, "In fact, for children with leukemia does not need too much taboo, there is no 'hair' can not eat in medicine, high-quality protein is sufficient, meat and vegetarian balance is better, and there is no need to drink supplements such as stew soup." ”

Proofread by Faye Wong